Department of Family and Community Medicine, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA.
Hayward Score, Carmel, CA 93921, USA.
Int J Environ Res Public Health. 2021 Aug 18;18(16):8714. doi: 10.3390/ijerph18168714.
Chemical intolerance (CI) is characterized by multisystem symptoms triggered by low levels of exposure to xenobiotics including chemicals, foods/food additives, and drugs/medications. Prior prevalence estimates vary from 8-33% worldwide. Clinicians and researchers need a brief, practical screening tool for identifying possible chemical intolerance. This large, population-based study describes the validation of a three-item screening questionnaire, the Brief Environmental Exposure and Sensitivity Inventory (BREESI), against the international reference standard used for assessing chemical intolerance, the Quick Environmental Exposure and Sensitivity Inventory (QEESI).
More than 10,000 people in the U.S. responded to the BREESI and the QEESI in a population-based survey. We calculated the overall prevalence of CI in this sample, as well as by gender, age, and income. Common statistical metrics were used to evaluate the BREESI as a screener for CI against the QEESI.
The prevalence estimate for QEESI-defined chemical intolerance in the U.S. was 20.39% (95% CI 19.63-21.15%). The BREESI had 91.26% sensitivity (95% CI: 89.20-93.04%) and 92.89% specificity (95% CI: 91.77-93.90%). The positive likelihood ratio was 12.83 (95% CI: 11.07-14.88), and the negative likelihood ratio was 0.09 (95% CI: 0.08-0.12). Logistic regression demonstrates that the predicted probability of CI increased sharply with each increase in the number of BREESI items endorsed (Odds Ratio: 5.3, 95% CI: 4.90-5.75).
Chemical intolerance may affect one in five people in the U.S. The BREESI is a new, practical instrument for researchers, clinicians, and epidemiologists. As a screening tool, the BREESI offers a high degree of confidence in case ascertainment. We recommend: screen with the BREESI, confirm with the QEESI.
化学敏感性（CI）的特征是多系统症状，由低水平的外源性化学物质、食物/食物添加剂和药物/药物暴露引起。全球范围内的先前患病率估计值在 8%至 33%之间不等。临床医生和研究人员需要一种简短、实用的筛查工具来识别可能的化学敏感性。这项大型的基于人群的研究描述了一个三项目筛查问卷，即简要环境暴露和敏感性调查表（BREESI），与用于评估化学敏感性的国际参考标准，即快速环境暴露和敏感性调查表（QEESI）的验证。
美国有超过 10000 人在一项基于人群的调查中回答了 BREESI 和 QEESI。我们计算了该样本中 CI 的总体患病率，以及按性别、年龄和收入划分的患病率。常用的统计指标用于评估 BREESI 作为 QEESI 定义的 CI 的筛查工具。
美国 QEESI 定义的化学敏感性患病率估计为 20.39%（95%CI 19.63-21.15%）。BREESI 的灵敏度为 91.26%（95%CI：89.20-93.04%），特异性为 92.89%（95%CI：91.77-93.90%）。阳性似然比为 12.83（95%CI：11.07-14.88），阴性似然比为 0.09（95%CI：0.08-0.12）。Logistic 回归显示，随着 BREESI 项目数的增加，CI 的预测概率急剧增加（优势比：5.3，95%CI：4.90-5.75）。
化学敏感性可能影响美国五分之一的人。BREESI 是一种新的、实用的研究人员、临床医生和流行病学家的工具。作为一种筛查工具，BREESI 在确定病例方面具有高度的置信度。我们建议：使用 BREESI 进行筛查，使用 QEESI 进行确认。
